In the context of declining sales of cigarettes, the marketing and sale of smokeless tobacco is on the rise in the United States. Currently four major U.S. cigarette manufacturers have introduced new spitless, smokeless tobacco products modeled on Swedish snus and targeted specifically to cigarette smokers. There is considerable controversy about the appropriate public health approach to these new, relatively low nitrosamine, smokeless tobacco products. Nevertheless the growing availability of these products is a fact, and to date there is virtually no population-based data on the use of these products. The National Cancer Institute and the National Institute of Drug Abuse have issued a Program announcement seeking research to improve knowledge about the use of potential reduced exposure tobacco products, including developing surveillance systems and assessing behavior changes that may accompany their use such as dual use of cigarettes and smokeless products. This application is directed to those purposes. At this time, Indianapolis and Dallas/Ft. Worth are the only areas where the two major brands, Camel Snus and Marlboro Snus, are both available. By means of an efficient, dual-frame sampling approach, this study will carry out a population-based telephone survey of 4540 adults in those test markets designed to provide evidence of the nature of consumer receptivity to the new snus products, the rate at which smokers and nonsmokers are trying the product and either rejecting it or adopting it for regular use, and the likely impact of regular use on smoking patterns. In addition, the project will contribute to refinement of surveillance measures and will establish benchmarks for awareness, trial and regular use of snus as well as perceptions of harmfulness against which future comparisons can be made as advertising messages, marketing strategies and/or product constituents change. By including a cell phone supplement, it will increase knowledge of how omission of cell phone only households may bias estimates of snus use, and build capacity to integrate cell phone samples into population surveys. Finally, if the rate of snus adoption is high enough to warrant continued study, this project will provide a panel of respondents who can be followed over time. PUBLIC HEALTH RELEVANCE: Low nitrosamine smokeless tobacco products being marketed to cigarette smokers in the U.S. could potentially undermine motivation to quit smoking, and increase the prevalence of tobacco addiction and related disease. On the other hand, they could reduce cigarette consumption which would lower disease risk. This study provides an initial look at how the population of two cities is responding to the products.